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the Privacy Act 5 U.S.C. § 552a and has been cleared for distribution.

DRAFT Report to the Secretary on Dose Reconstruction Case Reviews Completed by the 

Advisory Board on Radiation and Worker Health 

Findings for 166 Dose Reconstruction Cases Reviewed (Sets 14–21) and 

Comparisons to Dose Reconstruction Cases Previously Reviewed

May 13, 2019 

Dedicated to the memory of James Malcolm Melius, 

M.D., Dr.PH.

Member (2001–2018) and Chair (2009–2018), Advisory Board 

on Radiation and Worker Health

Chair, Steering Committee, World Trade Center Medical 

Monitoring and Treatment Program (2011–2018)

“For us on the Advisory Board on Radiation and Worker Health, Jim Melius 

was a consummate bridge builder between all three perspectives represented 

on this Board: scientific, medical and worker.

“In this pursuit, he was patient, humorous, attentive and insightful in doing 

his part to bring us as closely into consensus as possible for a given decision. 

Throughout our activities, he was caring of his fellow Board Members, of the 

program and the Board staff as well as the claimants, their families and 

advocates.” 

— Dr. Paul Ziemer on behalf of the Advisory Board on Radiation 

and Worker Health, April 11, 2018 
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TABLE OF CONTENTS

INTRODUCTION .......................................................................................................................... 3

OVERVIEW OF REVIEW PROCEDURES ................................................................................. 4

FINDINGS ...................................................................................................................................... 5

CONCLUSIONS........................................................................................................................... 22

RECOMMENDATIONS.............................................................................................................. 23

TABLES

Table 1. Types of Dose Reconstruction for the First 48,089 DRs .................................................. 6

Table 2. Changes Over Time in Board Utilization of Dose-Reconstruction Efficiency Measures 8

Table 3. Findings by Type of Issue for Sets 14–21 ...................................................................... 10

Table 4. Blind Case Reviews ........................................................................................................ 12

Table 5. Classification of Review-Case Issues Among a Subset of Cases within Sets 14–18 and 

All Cases within Sets 19–21 ......................................................................................................... 21

FIGURES

Figure 1. Breakdown of 166 Case Reviews by Employment Site ................................................ 14

Figure 2. Comparison of Claims Reviewed to Goal of 1% Total Claims ..................................... 15

Figure 3. Breakdown of 166 Case Reviews by Probability of Causation ..................................... 16

Figure 4. Breakdown of 166 Case Reviews by Years of Employment ........................................ 18

Figure 5. Breakdown of 166 Case Reviews by Types of Cancer Risk Model .............................. 19

Figure 6. Breakdown of 166 Case Reviews by Decade First Employed ...................................... 20
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INTRODUCTION

Under the Energy Employees Occupational Illness Compensation Program Act of 2000 

(EEOICPA), the Advisory Board on Radiation and Worker Health (the Board) is required to 

“verify a reasonable sample of the doses” calculated by the National Institute for Occupational 

Safety and Health (NIOSH) through its radiation dose reconstructions for claimants with cancer 

who apply for compensation. In the early years of the program, the Board established methods 

and procedures for conducting these verifications. The Board also established the Subcommittee 

for Dose Reconstruction Reviews (the Subcommittee) to select cases for review and oversee the 

reviews which were conducted by its technical support contractor, SC&A Inc. The Board has 

judged that a review by the Subcommittee of one percent of individual dose reconstructions is 

adequate and has established this as a current program goal. 

In July 2009, the Board reported to the Secretary of the Department of Health and Human 

Services (the Secretary) its findings of the first 100 individual dose reconstruction cases it 

reviewed (Case Review Sets 1-5). Then in December 2016, the Board submitted a second report 

to the Secretary that covers its review of an additional 232 individual cases (Sets 6-13) and 14 

blind case reviews. The current third report (2020) covers the review of an additional 166 

individual cases (Sets 14 - 21), as well as an additional 18 blind case reviews. In sum, the Board 

has reviewed a total of 498 dose reconstruction cases and 32 blind reviews selected from the total 

of 48,089 dose reconstructions completed by NIOSH as of September 9, 2014 (Sets 1-21). This

report provides background information on the methods used to select cases for review, the 

review procedures and methodologies, the findings of this review, and the Board’s conclusions 

and recommendations. 
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OVERVIEW OF REVIEW PROCEDURES

The Subcommittee selects the dose reconstruction (DR) cases to be reviewed in consultation 

with the Board. The cases eligible for review include only claims that have been fully 

adjudicated by the Department of Labor (DOL). The cases for this review were selected based on 

several criteria which have been modified over time to obtain better representation of covered 

facilities, employment periods, occupations and cancer diagnoses. Also, selection was targeted 

to include case reviews whose dose reconstructions involved using efficiency measures to 

expedite claims adjudication when possible. The dose estimates of cases selected for review are 

most frequently close to the compensable level, with probabilities of causation in the range from 

45 to 52 percent. The reviewed cases and their selection are described in more detail below. 

The selected cases are referred to SC&A, which provides technical and scientific expertise to 

assist the Board in conducting its work. SC&A reviews the case files and then repeats the dose 

reconstruction procedures used by NIOSH for that case in an attempt to verify the NIOSH 

findings. SC&A then prepares a report on its findings and observations for each case, covering 

any concerns SC&A might have about how the DR was conducted. In turn this report is 

reviewed by NIOSH, allowing it an opportunity to respond to the findings and observations in 

the report. The Subcommittee then conducts a systematic review of the SC&A report and 

NIOSH comments, following a standard template and evaluation process that addresses concerns 

raised by both groups. The Subcommittee also considers the severity of the findings for each 

case (i.e., the potential impact of the findings on a claim’s compensability). If during the review 

of cases, the Subcommittee identifies potential problems with the specific procedures or 

documents used in the DR, it may then refer these problems to Board work groups or other 

subcommittees for further evaluation. If it identifies potential problems with the review methods 

employed by SC&A or its findings and observations, it may amend them accordingly. 

Preliminary to submission of SC&A’s report to the Subcommittee each case is first presented to 

two Board members for initial review and discussion. Thus all Board members participate in this 

phase of the review process, with each assigned to review a limited number of cases. SC&A’s 

report on each case may be modified in light of the Board members’ reviews and sent to the 
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Subcommittee for resolution as indicated in the above paragraph. This process, preliminary to 

the Subcommittee review, allows each Board member to become better aware of and involved in 

the review process, whether or not she/he is a member of the Subcommittee. 

For a small proportion of the reviewed cases, SC&A is tasked by the Board to independently 

review the case as presented to NIOSH and to independently conduct the dose reconstruction and 

calculate the dose estimates, rather than just examining and assessing the procedures and 

decisions made by NIOSH. These are referred to in the report as “blind case reviews.” SC&A 

prepares a written report on each blind case and shares it with NIOSH before submission for 

review and finalization by the Subcommittee and the Board.

FINDINGS

Cases Sent to NIOSH for Dose Reconstruction

As of Sept. 9, 2014, NIOSH completed 48,089 DRs (Sets 1-21), from which the Subcommittee 

selected cases for review. All of the 48,089 DRs were returned to DOL with their Probability of 

Causation (POC) calculation for claims adjudication. The cases returned to DOL for 

compensation decisions included some claims that underwent DOL’s claim adjudication process

before HHS decided to add a class of employees to the Special Exposure Cohort (SEC) that 

would include those claims. Claims that are eligible for compensation through the SEC process 

will not require a dose reconstruction from NIOSH unless it involves multiple cancers, some of 

which are not covered under requirements of the SEC. 

Efficiency Measures for Dose Reconstruction

To provide a reasonable dose estimate for individual cases, NOSH may use one of three 

efficiency measures to expedite the process: 1) a best estimate; 2) an overestimate efficiency 

measure; or 3) an underestimate efficiency measure. NIOSH’s overestimating approach (i.e., 

over-estimate DR) is an efficient way to process claims that are evidently non-compensable

based upon cumulative program experience. The underestimation approach (i.e., under-estimate 

DR) is similarly a time-saving approach used for claims that are evidently compensable, without 

needing to take into account the entire work history of the employee whose dose is being 

reconstructed. Once the evidence of compensability is established during dose reconstruction, the 
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dose reconstruction work is curtailed because a more precise estimate of dose and resulting POC 

is not necessary. The best estimate approach (i.e., best-estimate DR) is used for cases that are 

not clearly compensable or non-compensable upon initial examination and gives the most precise 

estimate of dose and POC to support DOL’s claim adjudication. 

Dose Reconstruction Cases

As of September 9, 2014, NIOSH had completed 48,089 DRs covering review Sets 1-21. The 

distribution of DRs based on the use of efficiency measures and partial DRs is as follows 

(Table 1):

Table 1. Types of Dose Reconstruction for the First 48,089 DRs

Best estimate Overestimate Underestimate Partial** Total***

1,881 (3.9%) 33,682 (70.1%) 8,918 (18.6%) 3,608 (7.5%) 48,089 (100.1%)

Note: DRs for Sets 14-21 completed by NIOSH on September 9, 2014. Reviews of these DRs by 

Subcommittee were completed on August 16, 2018. 

** Partial dose reconstructions are conducted for claims involving facilities and work periods 

that have SEC class designations, but for which claimants are not eligible for inclusion. 

***Percentage exceeds 100% due to round-off errors. 

As indicated above a majority of the claims submitted (70.1 percent) were overestimated DRs, 

the second largest portion were underestimated DRs (18.6 percent), and only 3.9 percent of cases 

were reconstructed based on the more precise but also more elaborate and time-consuming bestestimate methods of DR. 

Partial dose reconstructions are conducted for claims from facilities and time periods that have 

SEC class designations but the claim is not eligible for coverage under the requirements of the 

SEC; these comprised the remaining 7.5 percent in Table 1. For these claims, NIOSH will 

estimate the limited set of radiation doses that remain feasible to estimate, enabling DOL to 

make a compensation decision based on those radiation doses. 

The results in Table 1 are similar to those presented in the Board’s 2016 Report, except for the 

best-estimate DRs, which appear to have decreased from 7.8% in the 2016 Report to 3.9% here. 

However this decrease is an artifact of a change by NIOSH in determining which cases are 

designated as best estimates. An examination by NIOSH of all cases determined to be best 
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estimates since the program’s inception indicates that in the early years of NIOSH’s dose 

reconstruction program many cases were completed using the best-estimate approach for 

administrative reasons that were independent of an assessment of the claim’s compensability; 

whereas for at least the past seven years the best-estimate approach was reserved for selected 

cases with probability of causation (POC) between 45 and 52 percent. Using the latter criterion 

NIOSH has found that the percentage of best-estimate cases with POCs between 45 and 52 

percent since the program’s inception is 3.9 percent, as reported in Table 1 above, rather than the 

greater (and inflated) value of 7.8 percent reported in 2016. 

Overall, 13.4 percent of the cases were claims filed by or on behalf of female energy employees. 

NIOSH does not collect data on the race or ethnicity of energy employees, except for those cases 

involving skin cancers, since differences in skin-cancer incidence rates by race have been 

scientifically observed and thus are taken into account during dose reconstructions. 

Dose Reconstruction Cases Reviewed

Of the DR cases reviewed for this report, the Subcommittee, under the direction of the Board 

with technical assistance from SC&A, and NIOSH, with its contractor, Oak Ridge Associated 

Universities (ORAU), has been able to undertake more reviews of best-estimate DRs. Although 

best-estimate DRs are relatively infrequent among all DRs completed under the program (Table 

1), they are particularly important in that variables in the dose estimates have greater impact on 

compensation decisions than variables involved in other types of efficiency measures. Also bestestimate DRs require much more extensive calculations, more complete records, and may 

involve professional judgment to a greater extent to address uncertain information than for overand under-estimated DRs. Hence reviews of best-estimate cases test more of the critical elements 

of the DR process with respect to supporting the accuracy of DOL’s compensation decisions. 

Cases for review in this report were selected significantly, but not solely, from among bestestimate DR cases already adjudicated by DOL. The criteria used in selecting these cases were 

POCs between 45 and 52 percent and with appropriate representation of Department of Energy 

and Atomic Weapons Employer facilities (i.e., covered facilities), claimant occupations, career 
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duration, chronological decades worked, and cancer diagnoses. More recently, gender has also 

been included as a selection criterion. 

In the 2016 Report, the 232 cases examined reflected the Board’s desire to focus intensively on 

reviews of best-estimate cases because of the sensitivity of their compensation decisions to the 

variables in the DR calculations. Thus in the 2016 Report, 83 percent of the 232 cases were best 

estimates. Remarkably only one of the cases of dose reconstruction undertaken by NIOSH until 

then (2016) had been found upon Subcommittee and Board review to need to have its initial 

compensation decision be changed, for a rate of compensation change of 0.3 percent among all 

cases reviewed since EEOICPA’s inception. Furthermore the need for this change was triggered 

not by any error of analysis or interpretation, but by new information gathered between the time 

of the NIOSH DR and the time of its Subcommittee and Board review. 

Of the 166 cases reported here for Sets 14-21 (Table 2), 140 (84%) were best estimates, 26 

(16%) were overestimates and none were underestimates. The percentage for best estimates

reported here is consistent with the 83% in the 2016 Report. Both of these percentages for best 

estimate cases reviewed highly oversampled from among the 3.9% of all 48,000 DRs that are 

best estimate cases conducted by NIOSH since the program’s inception (Table 1), reflecting as 

noted that the review of best-estimate cases tests more of the critical elements of the DR process

than do the Board’s review of the far larger proportions of over- or under-estimated dose 

reconstructions. Overall, as reflected in the bottom line of Table 2, of all 498 cases reviewed by 

the Board during the life of this program, two-thirds (68%) are best-estimate cases, about one 

quarter (27%) are over-estimates, and 5 percent are underestimates. 

Table 2. Changes Over Time in Board Utilization of Dose-Reconstruction Efficiency 

Measures

Cases Reviewed 

(Yr. of Report to Secretary)

Best 

Estimate

OverEstimateUnderEstimate

First 100 cases (2009) 7 (7%) 76 (76%) 17 (17%)

Next 232 cases (2016) 193 (83%) 32 (14%) 7 (3%)

Next 166 cases (2019)* 140 (84%) 26 (16%) 0 (0%)

Total Cases reviewed: 498 340 (68%) 134 (27%) 24 (5%)

*Reviews of these DRs completed August 16, 2018. 
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Findings among Reviewed Cases

Findings among reviewed cases are first discussed first by the respective staffs of NIOSH and 

SC&A and then by the Subcommittee. Upon examining the 166 cases from Sets 14-21, the 

Subcommittee reviewed a total of 243 findings (Table 3), an average of 1.46 findings per case. 

This is about half (54 percent) the level of 2.70 per case reported in 2016. 

Since the 2016 Report, the Subcommittee has continued to assess and categorize findings by type 

of issue resulting in the finding. These are presented for the 166 cases in Table 3. The largest 

single category, which accounts for 30 percent of the 243 findings, is incorrect use of external 

dose models and related assumptions, followed by 12 percent in the category of incorrect internal 

dose models and related assumptions. Both of these percentages were smaller than the 

corresponding rates reported in the 2016 Report (40 percent and 21 percent, respectively). These 

decreases result from overall improvement in the dose reconstruction program. 

Against the background of an overall decrease in the rate of findings, some categories of findings 

did increase proportionately: For example, quality concerns, related to dose reconstructors not 

properly carrying out mandated programmatic procedures, rose to 23% of the total number of 

issues compared to 15% in the 2016 Report. However in terms of absolute numbers, 55 instances 

of quality concerns were observed here among 166 review cases here (55/166 = 33%) compared 

to 95 instances among 232 review cases (95/232 = 41%) in the 2016 Report – so the rate of 

quality concern findings among reviewed cases has fallen from 41% to 33% since the 2016 

Report.

Finally the large percentage of findings (30%) which did not fit into any of the specific issue 

categories in Table 3 suggests a need to re-examine the reviews for this 30% of cases to 

determine if another category of issue or issues should be added to such a Table in the future. 

The Subcommittee will undertake this with assistance from NIOSH and SC&A.

Among the total 498 cases reviewed by the Subcommittee, 50 cases (10 percent) were filed 

either by female energy workers or survivors of female energy workers. This percentage is less 

than the 13.4 percent of claims involving a female energy worker among the 48,089 total claims. 
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While women have been employed in a wide range of occupations within covered facilities, they 

have traditionally been more heavily represented among administrative and clerical workers, 

who have typically experienced lesser exposures than other energy workers, and thus their DRs 

are more frequently completed using the overestimating efficiency methods. The Board’s 

emphasis on reviewing DRs with best-estimate methods might thusly account for the lesser 

percentage of claims involving female energy workers among reviewed cases. Among the 

current sets of cases being reviewed (Sets 14-21) and going forward, the Subcommittee has paid 

greater attention in its selection of cases to improved representation among covered facilities and 

a wider range of other characteristics, including gender. Thus there is good reason to expect that 

the percentage of female claimants’ cases reviewed will increase as this program continues. 

Was the proper judgment made regarding placing a person physically at a work location? 

Table 3. Findings by Type of Issue for Sets 14–21 

Type of Issue * No. Of Findings **

(Percent)

Was the proper judgment made regarding placing a person 

physically at a work location?

1 (0.4%)

Were all exposure scenarios considered (i.e., neutron, thorium)? 14 (6%)

Were the correct external dose model and assumptions used? 72 (30%)

Were the correct internal dose model and assumptions used? 28 (12%)

Was there a quality concern? 55 (23%)

Issues not covered by any of the above categories 73 (30%)

Total 243 (101%) ***

*NOTE: Some cases had more than one type of issue. 

** Unresolved findings were assigned their preliminary classification

*** Percentage exceeds 100% due to round-off errors. 

As a result of discussion and review of these 166 cases, none of the compensability outcomes for 

Sets 14-21 was changed. Thus of the grand total of 498 cases reviewed by the DRRSC since the 

program’s inception, only one had its compensation decision changed, resulting in a decrease of 

the changed decision rate from 0.3% to 0.2% of reviewed cases. 

Note that whenever an issue is identified to potentially have an impact on other similarly-situated 

DR cases, NIOSH will conduct a system-wide review of such cases. Based on its evaluation, 
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NIOSH may issue revised DRs as needed and coordinate with DOL in the event that the revised 

DRs might impact the claims’ compensability. Indeed, NIOSH utilizes the same process of 

reconsidering and revising DRs upon its own review and improvement of DR data and methods, 

independent of the Board’s and the Subcommittee’s reviews. 

Rate of Dose Reconstruction Cases Reviewed

In 2016, the Board established the goal of reviewing one percent of all DRs. As of August 16, 

2018, the Board had reviewed a total of 498 DRs of the 48,089 DRs which NIOSH had 

processed and completed for Sets 1-21 since the program’s inception. Thus, the Board has 

completed reviews of 1.04 percent (=498/48,089) of all claims requiring dose reconstruction as 

of this Report, thus continuing to achieve its current goal of reviewing one percent of all DRs 

completed. This result is consistent with the 1.05 percent reported in 2016. 

Blind Case Reviews

To further assure the scientific validity and quality of DRs performed, the Board conducts 

independent blind case reviews for a limited number cases by tasking SC&A to conduct 

independently DRs for cases already completed by NIOSH. The Board’s goal is to further and 

more meticulously examine a subset of NIOSH dose reconstructions to identify possible DR 

deficiencies. The Subcommittee compares SC&A’s and NIOSH’s results to assure that dose 

reconstruction cases were properly evaluated by NIOSH and that professional decisions made by 

NIOSH were grounded in the best available science and information at the time. While this 

blinds case review process is resource-intensive, it provides an additional avenue to evaluate how 

consistently two independent dose reconstructors can interpret the same data and move through 

the various decision points that might result in variations in the DRs that might potentially 

impact the claim’s compensability. 

Some variability in the paired POC values for each blinds case is expected, particularly due to 

professional judgments which must be made in light of inadequacies in the exposure data and/or 

in interpreting such data. However if the instruction given to the dose reconstructors and the 

procedures mandated are appropriate, then the vast majority of blinds cases should result in 

identical paired compensability outcomes. To more sensitively test the reliability of these paired 
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comparisons, most of these blinds cases were selected from among NIOSH best-estimate review 

cases. 

As shown in Table 4 below, a total of 32 cases have been reviewed using these procedures and 

for 31 (97%) the compensation decisions were identical. Fully 87 percent (= 27/32) of these 

cases were selected from best-estimate cases. 

For the single case in which the compensation decisions by NIOSH and SC&A did not agree 

(Case 3 in Table 4), the Subcommittee referred this case to the Surrogate Data Working Group 

for review. The Working Group agreed with the NIOSH approach, thus these 32 blinds DR case 

reviews have not identified any deficiency in the NIOSH dose reconstruction procedures that 

have impacted the compensability outcome. [NOTE: NIOSH conducts all DRs under EEOICPA, 

whereas SC&A conducts only a very limited number of DRs for the Board as part of its review 

process. Thus as noted above the main goal of this blinds process is to seek out possible 

deficiencies in NIOSH’s DR procedures – and so far none have been identified.] 

Table 4. Blind Case Reviews

Blind Case No. (Facility) POC by SC&A POC by NIOSH/DCAS

A. First contract period — —

1. Portsmouth Gas Diffusion 49.35% 48.75%

2. X-10 48.00% 43.63%

B. Set 17 Blinds — —

3. Allied Chemical & Dye* 85.40% 45.90%

4. Fernald 38.12% 48.27%

5. Hanford 43.18% 45.27%

6. Rocky Flats 42.65% 47.51%

7. Savannah River 51.00% 51.39%

8. Y-12 and X-10 50.47% 50.46%

C. Set 20 Blinds — —

9. Nevada Test Site 40.59% 41.17%

10. Hanford/Weldon Springs Plant 40.71% 42.49%

11. Hanford/Pacific NW Natl. Lab. 36.43% 42.31%

12. Rocky Flats 43.78% 42.91%

13. Brookhaven Natl. Lab. 51.05% 52.54%

14. Y-12 49.48% 49.46%
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Blind Case No. (Facility) POC by SC&A POC by NIOSH/DCAS

D. Set 22 Blinds — —

15. ANL-E 42.63% 46.19%

16. GJOO 47.92% 48.08%

17. LANL/NTS 42.43% 46.44%

18. Metals and Controls Corp 49.78% 46.60%

19. Rocky Flats Plant 50.19% 50.08%

20. SNL- ABQ 51.50% 50.57%

E. Set 23 Blinds — —

21. Nevada Test Site 44.57% 46.10%

22 FMPC 40.47% 48.64%

23. Hanford/PNNL/IOP 49.19% 47.31%

24. LLNL 50.73% 50.83%

25. Rocky Flats Plant 45.69% 48.44%

26. Sandia National Laboratories 43.08% 44.33%

F. Set 24 Blinds — —

27. Rocky Flats Plant 46.39% 47.19%

28. WR Grace 50.99% 51.56%

29. Mallinckrodt Chemical Co. 

Destrehan St 46.25% 45.40% 

30. FMPC 49.30% 47.90%

31. NTS/REECo 50.09% 51.61%

32. FMPC 45.89% 41.93%

* This case was referred by the Subcommittee to the Surrogate Data Working Group for review 

and evaluation. The Working Group agreed with the DR approach used by NIOSH. 

These results give the Board confidence that the instruction and procedures given to the 

program’s dose reconstructors are reliable and result in consistency among the DRs evaluated by 

them.

Distribution of Dose Reconstruction Cases among Covered Facilities

The Subcommittee, under the Board’s direction, has worked assiduously over the years to assure 

that cases selected for review represented an appropriate cross-section of covered facilities. The 

breakdown of covered facilities represented in Sets 14-21 is shown in Figure 1. As indicated, 34 

sites had only one case reviewed and 15 had two. Those with three or more review cases are 

represented individually. The average number of employment sites per case was 1.39 

(=231/166) for these cases. 
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Figure 1. Breakdown of 166 Case Reviews by Employment Site 

Note: For cases with multiple employment sites, each site is counted separately.

In Figure 2, the blue bar next to each of the 29 large and medium sites displayed represents the 

number of cases needed to be reviewed in order to achieve one percent of all DRs reviewed for 

that site. These 29 sites are ones for which at least four cases reviews are needed to achieve the 

one percent goal for that site. All other covered sites are combined into the “Remaining 1%” 

category [NOTE: The Board’s goal is to review one percent of the total of DR claims, not one 

percent of all DR claims from any given facility. Some facilities may require greater attention 

due to the complexity of the DRs involved.] 

The orange bar next to each named site displayed in Figure 2 is the sum of cases reviewed by the 

Subcommittee and Board from that site among the 498 total cases reviewed. The “Remaining 

34

27

17

17

17

15

15

12

11

10

9

8

7

4

4

4

4

4

3

3

3

3

0 5 10 15 20 25 30 35 40

Sites with 1 case

Hanford

Oak Ridge National Laboratory (X-10)

Savannah River Site

Y-12 Plant

Oak Ridge Gaseous Diffusion Plant (K-25)

Sites with 2 cases

Rocky Flats Plant

Nevada Test Site

Feed Materials Production Center (FMPC)

Paducah Gaseous Diffusion Plant

Pacific Northwest National Laboratory

Los Alamos National Laboratory

Idaho National Laboratory

Lawrence Livermore National Laboratory

Mound Plant

Pantex Plant

Portsmouth Gaseous Diffusion Plant

Amchitka Island Nuclear Explosion Site

Metals and Controls Corp.

Pacific Proving Ground

Sandia National Laboratories
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1%” category is the sum of all sites with three or less cases reviewed. Thus if the length of the 

orange bar exceeds that of the blue bar, then the reviews undertaken by the Subcommittee and 

Board have exceeded one percent of the DRs for that site. 

Figure 2. Comparison of Claims Reviewed to Goal of 1% Total Claims 

* For cases with multiple employment sites, each site is counted separately.

As indicated in Figure 2, the Board has met or exceeded the goal of one percent of cases

reviewed for 19 of the 29 sites, and has not met this measure for the other 10 named sites. For 

sites with zero to three reviewed cases (Figure 2, “Remaining 1%”) the Subcommittee’s review 

far exceeded the one percent goal – at 1.26 percent with 122 reviews completed when 97 would 
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have been needed to achieve one-percent reviewed. This gives evidence that sites with small 

numbers of total claims were accorded appropriate attention during the review process. 

Distribution of Probabilities of Causation among Cases Reviewed

Figure 3 shows the distribution of POCs among the 166 cases reviewed in Sets 14-21. Cases with 

POC between 45 and 52 percent have long been targeted for review. 

Figure 3. Breakdown of 166 Case Reviews by Probability of Causation 

Since a pie chart reflects percentages of a particular population or group under scrutiny and all of 

these percentages add up to 100%, this means that if, as in this case, both POC segments at or 

above 45% have declined since last report (from 51 to 49 percent), then the sum of all segments 

below 45% must necessarily increase – and this is observed. However among the three segments 

observed below POC = 45% (i.e., POC 40 to < 45, 20 to < 40 and < 20), only the segment 40 to< 

POC ≥ 50

14%

45 ≤ POC <50

25%

40≤ POC< 45

45%

20 ≤ POC <40

14%

POC < 20

2%
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45 increased – and it did so dramatically at 45% in this report compared to 22% in the previous 

report (2016). Both of the other two segments below POC = 45% (POC 20 to < 40 and < 20) 

declined. However this large increase in percentage in only one of the three expected POC 

categories is simply an artifact of changes in DR procedures in recent years: In earlier years of 

this program, to meet the demand for rapid processing of claims, dose reconstructors were 

permitted to truncate the reviews for cases far below the 50% compensation levels as soon as 

their analyses clearly showed non-compensability (Over-Estimated DRs). But often it was found 

that claims by the same persons came back later if and when other cancers developed or the 

original ones spread to more sites, as with skin cancers, or for partial DRs when SECs were 

granted. So in recent years dose reconstructors have been directed to complete the analyses of 

more of these over-estimated DRs. Overall, this results on average in an increase of POC values 

among the non-compensated claimant population and hence to a greater increase in the slice of 

POCs among non-compensated cases closer to POC=45% (i.e., POC 40 to < 44.9%) -- and this is 

what is observed here. 

Distribution of Dose Reconstruction Reviews by Years of Employment

Figure 4 shows the distribution of dose reconstructions by years of employment. About 63 

percent of the 166 cases reviewed have employment at covered facilities for 20 years or more. 

This is slightly below the 67 percent reported in the Board’s 2016 Report. For lesser employment 

periods, 17 percent of the cases have employment for 10 to 20 years and 20 percent for less than 

10 years. The former figure is four percent larger than the corresponding one in the 2016 report 

and the latter identical. The decreased percentage of claims with 20 years of employment or 

greater (four percent less) thus resulted in an equal and opposite percentage increase for those 

below 20 years (four percent more). 
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Figure 4. Breakdown of 166 Case Reviews by Years of Employment

Distribution of Cases Reviewed by Cancer Risk Model

Figure 5 presents the breakdown of cases reviewed for 27 cancer risk models. There were 287 

cancer diagnoses for 166 cases, for an average of 1.73 cancer diagnoses reported per claim. The 

most frequently observed cancer diagnoses were Non-melanoma Skin (111 cases: 59 cases of 

basal cell carcinomas and 52 cases of squamous cell carcinomas), All Male Genitalia (52 cases)

and Lung (22 cases). These three leading cancer diagnoses were also observed in the 2016 

Report. However, the proportions of cases among these three differ: In this report, there are 

approximately twice as many cases of skin cancer as cancers of the male genitalia, whereas in 

the 2016 Report, skin cancer cases exceeded male genital cancers by 40 percent. Also in this 

report, male genital cases are more than double the number of lung cancer cases, whereas in the 

2016 Report the numbers of these two types were nearly equal. The differences in the 

proportions of these three risk model types simply reflect the differences in cancers among 

≤1

2%

1-5

10%

5-10

8%

10-20

17%

20-30

20%

30-40

37%

≥40

6%
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different groups of energy workers. It cannot be known from these claims data whether the 

differences relate to differences in risks among workers at different facilities or other potentially 

differing risk factors.

Figure 5. Breakdown of 166 Case Reviews by Types of Cancer Risk Model

Note: For claimants with multiple cancer diagnoses, each diagnosis was counted separately. 

Note: Among skin cancers, BCC is an abbreviation for basal cell carcinomas and SCC for 

squamous cell carcinomas.

Distribution of Cases Reviewed by Decade First Employed

Figure 6 presents the distribution of the 166 cases reviewed in this report by decade first 

employed. Over half (56 percent) of the cases reviewed involve energy workers who were first 

employed before 1960, down from 72 percent in the 2016 Report. This reflects the expected 

1

1

1

2

2

2

2

3

3

4

4

4

4

4

6

6

6

6

7

7

7

9

11

22

52

52

59

0 10 20 30 40 50 60 70

Connective Tissue

Eye

Rectum

Pancreas

Brain/Nervous System

Breast

Other and Ill Defined

Gallbladder

Female Genitalia

Acute Myeloid Leukemia

All Digestive

Urinary excluding bladder

Oral Cavity and Pharynx

Liver

Chronic Lymphocytic Leukemia

Bone

Colon

 Lymphoma and Multiple Myeloma

Stomach

Other Respiratory

Thyroid

Bladder

Malignant Melanoma

Lung

All Male Genitalia

Non-melanoma Skin (SCC)

Non-melanoma Skin (BCC)
20 

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decline in eligible claims from older, long-term employees and their survivors. Similarly, among 

these 166 cases the percentage of cases involving energy workers who first started working in 

covered facilities in the 1960s has increased to 37 percent from 18 percent in the 2016 Report. 

And in the 1970s and 1980s the percentages of claimants from these decades are up to 13 percent

and 7 percent, respectively compared to 6 percent and 4 percent in 2016. There were no 

claimants who started work in the 1990s in the 2016 Report, whereas there is now 1 percent. 

Such trends will of course continue as the claimant population ages. 

Figure 6. Breakdown of 166 Case Reviews by Decade First Employed 

Administrative Changes to Enhance Review Efficiency

In the midst of its reviews of cases in Sets 14-18, the Board modified one aspect of its 

procedures in order to improve review efficiency – namely, NIOSH and SC&A were approved 

and encouraged to engage more actively in technical discussions to address concerns raised by 

SC&A in examination of NIOSH case reviews. If such joint technical discussions successfully 

1930s

2%

1940s

17%

1950s

37%

1960s

23%

1970s

13%

1980s

7%

1990s

1%
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resolve these issues, then NIOSH and SC&A present these suggested case-review resolutions to 

the Subcommittee for review and approval -- these are called Type 1 review cases. These can be 

resolved relatively quickly, which saves Subcommittee time and allows it to focus on the more 

complicated review cases (Type 2 issues), in which the differences cannot be resolved during 

NIOSH and SC&A talks. In either circumstance, all review cases are discussed and finally 

resolved by the Subcommittee. 

This modified procedure was then continued for all review cases in Sets 19-21, saving 

considerable Subcommittee time, and will be used in all further review sets. Data on the 

distribution of issues resolution since adoption of this procedure are presented in Table 5. 

As noted, two-thirds of the 278 findings and observations reviewed by the Subcommittee are of 

the more rapidly resolved Type 1 issues. 

Table 5. Classification of Review-Case Issues Among a Subset of Cases within Sets 14–18 

and All Cases within Sets 19–21 

Type of Issue * Nr. cases (Pct.) **

Type 1 Issues 189 (68%)

Type 2 Issues 89 (32%)

Total 278 (100%)

*Includes both findings and observations for reviewed cases. Since there may 

be more than one issue (finding and/or observation) for each case, the 

number of issues resolved exceeds the number of cases reviewed. 

**Classification applied midway through issues resolution of Sets 14-18 and 

includes all issues among Sets 19-21.

Other Board Review Activities

In interpreting the results of these individual case reviews, it is important to consider this review 

process in the context of other reviews conducted by the Board. The DRs are based on a large 

number of technical documents which provide a description and history of the activities at each 

covered facility and potential sources of radiation exposure over time for people working at that 

facility. In addition, a large number of other reference documents have been developed for use 

in the dose reconstruction process. These documents are continually revised to reflect newly 

available information so as to improve the dose reconstruction process. The Board has reviewed 
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nearly all of these documents and its recommendations to improve these documents are

implemented by NIOSH. 

In addition, there have been many petitions to add classes of energy employees at specified

facilities and time periods to the Special Exposure Cohort (SEC). NIOSH first evaluates these 

petitions to determine whether adequate information is available to estimate doses for all workers 

and all cancer types at that particular site and during that time period. If NIOSH determines that 

it does not have sufficient information to estimate these with sufficient accuracy, then it

recommends adding the class of evaluated workers to the SEC. Energy employees who are 

members of the SEC do not need to undergo the dose reconstruction process in order to receive 

monetary and medical benefits under Part B of EEOICPA (for those 22 “specified cancers” 

covered by the SEC requirements). The Board then independently evaluates NIOSH’s findings 

and transmits its recommendation to the Secretary on whether or not to add a class of workers. 

The Secretary makes the final decision on whether or not to add the class of workers to the SEC. 

These other review activities by the Board have a direct effect on the Board’s verification of dose 

reconstructions. Often while an individual case is being reviewed or after the review, a 

procedure or other technical document used in the dose reconstruction is revised in light of the 

newly available information or in response to a recommendation from the Board’s Subcommittee

on Procedure Reviews. The Board’s review of an individual case may not reflect these changes. 

It relies only on the procedures and information in place at the time that the dose reconstruction 

was completed. However, NIOSH reviews and revises, if needed, individual DRs that may be 

impacted by a change in procedure or other technical document used in the dose reconstruction 

at its own initiative, and notify DOL if the revised DRs may affect their compensability. 

CONCLUSIONS

1. The Board continues to reach its goal of reviewing one percent of all DR claims during 

this third report to the Secretary.

2. Since the 2016 Report, the Subcommittee has reviewed another 166 DR cases, which 

yielded a total of 243 findings (1.46 findings per case reviewed), a drop in findings rate 
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of almost 50 percent from the 2016 Report. This review shows that none of the findings 

resulted in revisions to the completed DRs to the extent that they would subsequently 

change the compensation decisions made by DOL. 

3. The Subcommittee continues to solicit blind-case reviews, in which dose reconstructors 

from SC&A independently conduct DRs on cases already completed by NIOSH and 

reported their results back to the Subcommittee for review. As of this report, 32 blinds 

cases have been reviewed. Findings from these cases affirm that the DR procedures 

undertaken by NIOSH were properly and professionally carried out. This is a strong 

validation of the consistency of dose reconstructions performed under this program. 

4. The above three conclusions along with the Board’s ongoing reviews of the NIOSH dose 

reconstruction procedures provides the Board with a high level of confidence that the 

dose reconstruction process now in place is scientifically sound and consistent among 

various dose reconstructors. However, it should be noted that the methods and 

information used for dose reconstruction process are not static. As new information 

becomes available on the many sites covered by this program and procedures are further 

developed, the DR methods used in this program will also be improved to better reflect 

this new information and improved procedures. 

RECOMMENDATIONS 

Based on the findings of this report and the Board’s further deliberations, the Board recommends 

the following: 

1. The Board should continue to review at least one percent of the total DR cases. 

2. The Board should continue to conduct blind-case reviews at the current rate. 

3. The Board should modify the review process to make it more efficient and timely by 

focusing more effort on the critical parts of dose reconstruction evaluation. In particular, 

the Board should initiate a process to conduct reviews focused on evaluating the 
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consistency and accuracy of dose reconstructions for cases where the dose reconstructors 

must make individual judgments about what exposure data or other information should be 

used for conducting the dose reconstruction and where these choices are not prescribed 

by the guidance documents applicable to that site. The Board will work with the 

Subcommittee, NIOSH and the technical contractors to identify key targets and 

methodologies to implement these more focused reviews.